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A Pipeline for 3D Multimodality Image Integration and Computer-assisted Planning in Epilepsy Surgery
Published on: May 20, 2016
12.7K
Surgery for epilepsy
Siobhan West1, Sarah J Nevitt, Jennifer Cotton
1Department of Paediatric Neurology, Royal Manchester Children's Hospital, Hathersage Road, Manchester, UK, M13 0JH.
The Cochrane Database of Systematic Reviews
|June 26, 2019
Summary
Epilepsy surgery can cure focal epilepsy in up to 64% of patients, but evidence quality is limited. Identifying prognostic factors like abnormal MRI can improve patient selection for better seizure control.
Area of Science:
- Neurology
- Neurosurgery
- Clinical Trials
Background:
- Focal epilepsies stem from localized brain dysfunction, affecting 20-70% of individuals unresponsive to medication.
- Surgical resection offers a potential cure for epilepsy if the epileptogenic zone is precisely identified.
- This review updates evidence on epilepsy surgery outcomes, focusing on randomized controlled trials (RCTs).
Purpose of the Study:
- To assess epilepsy surgery outcomes using evidence from randomized controlled trials (RCTs).
- To evaluate outcomes based on non-randomized evidence.
- To identify factors predicting seizure remission after surgery.
Main Methods:
- Searched multiple databases including Cochrane Register of Studies, MEDLINE, and ClinicalTrials.gov up to March 2019.
- Included RCTs with ≥30 participants, defined populations, MRI in ≥90%, and ≥1-year follow-up for seizure control outcomes.
- Assessed study quality using EPHPP and QUIPS tools; extracted data on seizure control and prognostic factors.
Main Results:
- 182 studies with 16,855 participants were analyzed; 9 RCTs were included, with high or unclear risk of bias.
- Surgery was superior to medical treatment in 2 RCTs; other RCTs showed no significant differences for various surgical approaches.
- 64% of 16,756 surgical patients achieved good seizure control; outcomes varied widely (13.5%-92.5%).
- Positive prognostic factors included abnormal pre-operative MRI, complete resection, and mesial temporal sclerosis.
- Data quality on adverse events was very poor.
Conclusions:
- Limited evidence exists due to study design issues and insufficient information, hindering patient selection and outcome prediction.
- Future research requires high-quality, prospective, and adequately powered studies focusing on diagnostic tools and surgical approaches.
- Standardized reporting of prognostic factors using multivariable regression and adverse events is crucial for advancing epilepsy surgery.
